EP2170185A2 - Sphincterotome cutting wire improvement - Google Patents
Sphincterotome cutting wire improvementInfo
- Publication number
- EP2170185A2 EP2170185A2 EP08771817A EP08771817A EP2170185A2 EP 2170185 A2 EP2170185 A2 EP 2170185A2 EP 08771817 A EP08771817 A EP 08771817A EP 08771817 A EP08771817 A EP 08771817A EP 2170185 A2 EP2170185 A2 EP 2170185A2
- Authority
- EP
- European Patent Office
- Prior art keywords
- sphincterotome
- wire
- xylylene
- cutting wire
- coating
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
- A61L31/08—Materials for coatings
- A61L31/10—Macromolecular materials
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00059—Material properties
- A61B2018/00071—Electrical conductivity
- A61B2018/00083—Electrical conductivity low, i.e. electrically insulating
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00107—Coatings on the energy applicator
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00107—Coatings on the energy applicator
- A61B2018/00136—Coatings on the energy applicator with polymer
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00529—Liver
- A61B2018/00535—Biliary tract
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00553—Sphincter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/144—Wire
Definitions
- the present device relates to medical devices, and specifically to improvements to devices such as sphincterotomes, also known as papillotomes.
- a sphincterotome may be used in conjunction with an endoscope to provide surgical cutting inside a patient.
- a sphincterotome is used during certain procedures to make an incision in a sphincter.
- a common treatment of cholecystitis includes the removal of gallstones from the common bile duct. This is frequently done endoscopically with the use of a duodenoscope.
- the common bile duct proceeds from the junction of the common hepatic duct with the cystic duct, which is open to the gall bladder, and merges with the pancreatic duct, forming the ampulla of Vater, which itself opens into the duodenum at the papilla of Vater.
- the sphincter of Oddi is a muscular ring that controls passage of fluid from the ampulla of Vater into the duodenum. For removal of gallstones in an endoscopic procedure, access to the common bile duct for removal of gallstones is eased using a sphincterotome to incise or sever the sphincter of Oddi.
- the sphincterotome is introduced through the duodenoscope and guided through the duodenum to the common bile duct. Once the sphincterotome is guided into the sphincter, its cutting element, commonly a needle knife or cutting wire, is used to incise the sphincter, and thereby improve access to the bile duct and impacted gallstones.
- its cutting element commonly a needle knife or cutting wire
- ERCP endoscopic retrograde cholangiopancreatography
- a diagnostic visualization technique used for variety of clinical applications.
- a contrast fluid such as a radio-opaque dye is introduced through a tube into the ampulla of Vater.
- a sphincterotome is often employed to provide access through the sphincter of Oddi in the same manner as described above.
- ERCP is often used in diagnosis of cholecystitis, as well as in the diagnosis and treatment of other conditions of the pancreatic and common bile ducts and related structures.
- a typical sphincterotome 100 includes a polymer tubular shaft 102 made of PTFE (polytetrafluoroethylene) or another flexible material.
- An electroconductive filament 104 also called a drive wire, is disposed in a lumen 106 running through the shaft 102. The distal end of the filament 104 is connected or anchored to the distal end of the shaft 102. A short segment of the electroconductive filament 104 near the distal end thereof is disposed outside of the shaft 102 for use as an electrocautery cutting wire 108.
- the proximal end of filament 104 is connected to the proximal handle assembly 110 such that actuation of the handle assembly 110 partially retracts (i.e., pulls in a proximal direction) the filament 104 relative to the polymer shaft 102. This actuation results in the distal end of shaft 102 bowing to form an arc 112, with the exposed filament forming a secant of the arc 112 so as to form a cutting wire 108.
- Electric current passed through the filament 104 from an electrode 114 in the handle assembly 110 enables the cutting wire 108 to act as an electrosurgical cutting element that may be used effectively to cut and cauterize tissue, such as the sphincter of Oddi in the example procedures described above.
- tissue adjacent the sphincter of Oddi may inadvertently be cut.
- the papillary tissue around the sphincter often protrudes as a folded surface.
- the adjacent papillary folds may inadvertently be cut or otherwise damaged by a portion of the cutting wire 108 adjacent the portion thereof that is actually incising the sphincter.
- Another problem that can occur is that current may arc from the exposed cutting wire to the endoscope or another structure.
- the cutting wire may break, rendering the sphincterotome useless, and potentially even releasing one or more wire fragments, which may pose an injury risk.
- Physical structural constraints of the sphincterotome prevent this from being accomplished by having only a small enough arc 112 to target the cutting wire in this manner.
- some sphincterotomes have included a coated portion of the cutting wire. These devices typically use PTFE or another polymer in the form of a sleeve. These coating sleeves also suffer from shortcomings.
- the sleeve may be nicked or split (e.g., by contact with an elevator of an endoscope), or may migrate longitudinally in a manner that exposes the wire and negates the intended insulating effect.
- This type of sleeve coating also increases the outer diameter of the cutting wire. Therefore, there is a need for a sphincterotome wire coating that provides desirable electro- insulation, resists damage, and does not significantly increase cutting wire diameter.
- Embodiments of the present invention include a polymeric coating that addresses the aforementioned needs by providing a thin but durable electroinsulative coating for a sphincterotome cutting wire.
- the present invention may include a sphincterotome that has a cutting wire including a coated portion.
- the coated portion may include a parylene coating such as a coating selected from the group consisting of poly-p-xylylene, 2-chloro-p-xylylene, 2, 4-dichloro-p-xylylene, poly(tetraflouro- p-xylylene), poly(carboxyl-p-xylylene-co-p-xylylene), fluorinated parylene, parylene HT, and any combination thereof.
- a parylene coating such as a coating selected from the group consisting of poly-p-xylylene, 2-chloro-p-xylylene, 2, 4-dichloro-p-xylylene, poly(tetraflouro- p-xylylene), poly(carboxyl-p-xylylene-co-p-xylylene), fluorinated parylene, parylene HT, and any combination thereof.
- the present invention may include a sphincterotome that has a cutting wire including a coated portion.
- the coated portion includes a bio-compatible polymeric coating means for providing a generally uniform bonded surface covering having a static coefficient of friction below about 0.4, for bonding to the cutting wire, and for providing an electroinsulative layer.
- the present invention may include a method of making a sphincterotome having a partially electroinsulated cutting wire.
- the method includes providing a sphincterotome cutting wire, then coating at least a portion of the cutting wire with a polymeric coating selected from the group consisting of poly-p-xylylene, 2-chloro-p-xylylene, 2, 4-dichloro-p-xylylene, poly(tetraflouro-p-xylylene), poly(carboxyl-p-xylylene-co-p-xylylene), fluorinated parylene, parylene HT, and any combination thereof.
- the present invention may include a method of cannulating a constricted structure by providing a sphincterotome including a shaft, a drive wire disposed longitudinally through a lumen of said shaft except for a distal cutting wire portion of the drive wire exposed outside the shaft, and a handle configured to tension the drive wire relative to the shaft in a manner that arcs a distal shaft portion.
- the distal drive wire portion may include an electroinsulated region and a non-electroinsulated cutting region immediately adjacent thereto.
- the electroinsulated region may include a coating selected from the group consisting of poly-p-xylylene, 2-chloro-p-xylylene, 2, 4-dichloro-p- xylylene, poly(tetraflouro-p-xylylene), poly(carboxyl-p-xylylene-co-p-xylylene), fluorinated parylene, parylene HT, and any combination thereof.
- the method also includes directing a distal sphincterotome region to a constricted structure in need of cannulation, contacting the constricted structure with the cutting region, and directing an electrical current to the cutting region.
- FIG. 1 shows a typical sphincterotome
- FIGS. 2-2A depict a sphincterotome embodiment of the present invention, including a coated wire portion;
- FIGS. 3A-3D show a method of making a sphincterotome with a coated wire
- FIGS. 4A-4B illustrate a method of using a sphincterotome of the present invention
- FIGS. 5A-5C show another method of making a sphincterotome with a coated wire.
- FIGS. 2-2A depict a sphincterotome 200 of the present invention, which includes a polymer tubular shaft 202 that may be constructed, for example, of PTFE or a similarly suitable material.
- An electroconductive drive wire 204 extends longitudinally from a handle assembly 210 through a lumen 206 that extends through a major length of the shaft 202.
- the distal-most end of the drive wire 204 is attached by a soldered-on cannula 205 to an electrocautery cutting wire 208 near the distal end of the shaft 202.
- the cutting wire 208 has a smaller outer diameter than the drive wire 204.
- a short length of the cutting wire 208 near the distal end of the shaft 202 extends outside of the shaft 202.
- the drive wire 204 is generally parallel with the longitudinal axis of the shaft 202.
- a proximal end portion of drive wire 204 preferably is connected to the proximal handle assembly 210 such that actuation of the handle assembly 210 pulls the drive wire 204 in a proximal direction relative to the shaft 202. This actuation results in a distal portion of the shaft 202 bowing to form an arc 212, with the exposed cutting wire portion 208 forming a secant of the arc 212 so as to form a transecting cutting wire portion 208.
- a portion of the cutting wire 208 is coated with a polymeric coating 220.
- the distal region of the shaft 202 is shown magnified in longitudinal cross-section in FIG. 2A, and the thickness of the coating 220 is not shown to scale.
- a wire guide lumen of the shaft is not shown, although those of skill in the art will appreciate that many sphincterotomes include a wire guide lumen configured for short-wire and/or long-wire applications.
- a preferred coating of the present invention may be between a fraction of a micron and several thousandths of an inch in thickness.
- a preferred coating also preferably includes a low coefficient of friction and is electroinsulative.
- a cutting portion 208a of the transecting wire 208 remains uncoated.
- electric current passed through the drive wire 204 from an electrode 214 in the handle assembly 210 enables the cutting portion 208a to act as an electrosurgical cutting element that may be used effectively to cut and cauterize tissue (such as, for example, the sphincter of Oddi during a sphincterotomy procedure providing access to the biliary tree).
- the cutting portion 208a is shorter than the transecting wire portion of the cutting wire 208 that is exposed out of the lumen 206.
- the coating 220 provides electroinsulation such that the cutting portion 208a may be used in a highly targeted manner to incise only desired tissue with minimal risk to adjacent tissue.
- a sphincterotome of the present invention may include a 35 cm cutting wire having an exposed transecting wire portion of about 20, 25, or 30 mm in length, with about 8 to about 10 mm of that length being configured for use as a cutting portion and not covered with an electroinsulative coating. In such a sphincterotome embodiment, the coating may cover about 5 cm of the wire's length.
- This coating length provides for a more proximal coated portion of the cutting wire extending well into lumen, which provides a safety feature.
- a cutting portion of about 8 to about 10 mm provides an ideal length for incision of a sphincter while minimizing likelihood of damage to adjacent tissues.
- a distal-most portion of the cutting wire mounted into the shaft of the sphincterotome in a manner known or developed in the art may be coated or uncoated.
- a highly preferred coating includes parylene-N (poly-p-xylylene).
- this coating requires less materials, provides superior electroinsulation and durability as well as cost advantages as compared to existing coatings such as, for example, PTFE.
- xylylene polymers and particularly parylene polymers, may also be used as a coating within the scope of the present invention, including, for example, 2-chloro-p-xylylene (Parylene C), 2, 4-dichloro-p-xylylene (Parylene D), poly(tetraflouro-p-xylylene), poly(carboxyl-p- xylylene-co-p-xylylene), fluorinated parylene, or parylene HT®(a copolymer of per-fluorinated parylene and non-fluorinated parylene), alone or in any combination.
- Parylene C 2-chloro-p-xylylene
- Parylene D 4-dichloro-p-xylylene
- poly(tetraflouro-p-xylylene) poly(carboxyl-p- xylylene-co-p-xylylene)
- fluorinated parylene or parylene HT®(
- Preferred coatings of the present will include the following properties: low coefficient of friction (preferably below about 0.5, more preferably below about 0.4, and most preferably below about 0.35); very low permeability to moisture and gases; fungal and bacterial resistance; high tensile and yield strength; high conformality (ready application in uniform thickness on all surfaces, including irregular surfaces, without leaving voids); radiation resistance (no adverse reaction under fluoroscopy); bio-compatible/bio-inert; acid and base resistant (little or no damage by acidic or caustic fluids); ability to be applied by chemical vapor deposition bonding/integrating to wire surface (bonding is intended to contrast to, for example, fluoroethylenes that form surface films that are able to be peeled off an underlying wire); and high dielectric strength. Parylene coatings, in particular, exhibit these qualities. See, for example, Table 1.
- the coating 220 is applied to the drive wire 204 by chemical vapor deposition ("CVD", which may include a plasma-assisted CVD process).
- CVD chemical vapor deposition
- Chemical vapor deposition is a well- known process in the art of electronic circuitry that is well-adapted for applying a coating, such as - for example - a parylene coating, to a wire. The process smoothly and uniformly applies the coating to the wire around its circumferential surface.
- a coated drive wire using a parylene coating presents advantages in coating durability, cost savings, and desirable outer diameter, while providing a coating with excellent lubricity (low friction) and electroinsulative qualities.
- a bonded coating of the present invention will not split or peel away from the wire due to frictional or traumatic contact with another surface such as, for example, an elevator or wire lock mechanism of an endoscope.
- a preferred drive wire of the present invention is electroconductive and may be constructed of stainless steel, nitinol, or another electroconductive material within the scope of the present invention.
- a single wire may be used wherein a distal portion of the drive wire may be used as a cutting wire.
- the cutting wire portion of the drive wire may include a reduced diameter.
- a reduced outer diameter of the cutting wire portion may allow it to form a more targeted cutting surface.
- the outer diameter of the drive wire may be substantially the same as that of the cutting wire portion, whether they are seamlessly continuous or connected by a cannula, weld, or some other connecting means.
- a sphincterotome may be provided using a coated drive wire.
- a coated drive wire One embodiment of such a method is illustrated with reference to FIGS. 3A-3D.
- a standard drive wire 300 is provided and proximal and distal portions 302, 304 are coated with a removable protective masking 310.
- Proximal portion 302 includes a major proximal length of the wire 300
- distal portion 304 includes the distal end of the wire 300
- an unmasked wire portion 308 is disposed therebetween.
- the unmasked wire portion 308 may be ground or otherwise treated to reduce its outer diameter such that a cutting wire portion thereof presents a smaller cross-sectional area for cutting as compared to the rest of the drive wire length.
- the removable protective masking 310 is provided to protect the drive wire 300 during the insulative coating application process. As depicted in FIG. 3B, an insulative coating 320 including a parylene or other appropriate coating is then applied using a chemical vapor deposition process. In this embodiment, the insulative coating 320 is applied to the unmasked wire portion 308 to form an electroinsulated wire portion 308. [00025] Then, as shown in FIG. 3C 1 the drive wire 300 may have the removable protective masking 310 removed.
- the drive wire 300 may then be assembled to a sphincterotome 350 (see FIG. 3D).
- FIG. 3D shows that when the drive wire 300 is assembled to the sphincterotome 350, the electroinsulated wire portion 308 extends outside the drive wire lumen 354 of the sphincterotome shaft 352.
- the non-electroinsulated portion of the drive wire 300 that is exposed outside the shaft 352 is immediately adjacent the distal tip 354 of the sphincterotome 350. In this manner, as described above, the short, non- electroinsulated length of the drive wire 300 is exposed for use as a cutting wire portion 312 that can function in a more targeted fashion than a wholly non- insulated cutting wire.
- Coating the wire in the targeted fashion of the described embodiment of a method will provide a desired electroinsulative coating, while also providing a minimal use of the electroinsulative coating and attendant cost savings.
- a greater length - up to and including the entire length - of the drive wire may be coated with an electro-insulative coating.
- the thinness and uniformity of the coating preferably are consistent along the wire length, but most preferably provide an integrity-maintaining coating in a region of the drive wire that is to be exposed outside the sphincterotome shaft but not intended to be used for cutting (specifically that region of the drive wire immediately adjacent the cutting wire portion and exposed outside the sphincterotome lumen during normal operation).
- the steps of assembling a drive wire to a sphincterotome are generally known in the art.
- FIGS. 5A-5C Another embodiment of such a method is illustrated with reference to FIGS. 5A-5C.
- a cutting wire 508 is provided and proximal and distal portions 502, 504 thereof are coated with a removable protective masking 510.
- the removable protective masking 510 is provided to cover the cutting wire 508 during the insulative coating application process, preventing a distal portion 512 from being coated.
- an insulative coating 520 including a parylene or other appropriate coating is applied using a chemical vapor deposition process. In this embodiment, the insulative coating 520 is applied to the unmasked portion of the cutting wire 508.
- a drive wire 500 may then be provided and attached to the cutting wire 508 by a cannula 509 or another connecting means (not shown to scale).
- the drive wire 500 may also have the removable protective masking 510 removed.
- the drive wire 500 may then be assembled to a sphincterotome 550.
- FIG. 5C shows that when the drive wire 500 is assembled to the sphincterotome 550, the electroinsulated wire portion 508 extends outside the drive wire lumen 554 of the sphincterotome shaft 552.
- the non- electroinsulated portion 512 of the cutting wire 508 that is exposed outside the shaft 552 is immediately adjacent the distal tip 554 of the sphincterotome 550.
- the short, non-electroinsulated length 512 of the drive wire 500 will be exposed for use as a cutting wire portion 512 that can function in a more targeted fashion than a wholly non-insulated cutting wire.
- the cannula 509 and the coating 520 are not shown to scale.
- a preferred coating of the present invention may be between a fraction of a micron and several thousandths of an inch in thickness.
- a greater length - up to and including the entire length - of the drive wire may be coated with an electro-insulative coating.
- the thinness and uniformity of the coating, whether applied by chemical vapor deposition or another process preferably are consistent along the wire length, but most preferably provide an integrity-maintaining coating in a region of the drive wire that is to be exposed outside the sphincterotome shaft but not intended to be used for cutting (specifically that region of the drive wire immediately adjacent the cutting wire portion and exposed outside the sphincterotome lumen during normal operation).
- the steps of assembling a drive wire to a sphincterotome are generally known in the art.
- a method of using a sphincterotome of the present invention for cannulating a constricted structure is shown in an embodiment of a sphincterotomy and described here with reference to FIGS. 4A-4B, with reference being made to the sphincterotome embodiment of FIG. 2.
- the shaft 202 of a sphincterotome 200 (a proximal portion of which, including the handle, is not shown) is directed through a working channel 402 of an endoscope 400.
- the distal end of the sphincterotome 200 is angled by an elevator 404 of the endoscope 400 to a location adjacent the papilla of Vater 450 where the common bile duct 456 meets the duodenum 454.
- FIG. 4A also shows the distal end portion of the sphincterotome 200 being directed through the papillary folds 450 and into the sphincter of Oddi 460 until the cutting portion 208a of the drive wire contacts the sphincter 460.
- the sphincterotome 200 can then be actuated both mechanically and electrically.
- the mechanical actuation includes a typical sphincterotome method of actuating the handle (not shown) to tension the drive wire relative to the shaft 202, thereby forming an arc 212 of the distal shaft 212, with the transecting wire 208 portion of the drive wire forming a secant thereof.
- the cutting portion 208a of the transecting wire 208 contacts the sphincter 460, and the electrical actuation (which includes directing an electrical current through the drive wire) provides for coagulative cutting of the sphincter 460 by the cutting portion 208a.
- the electrical actuation which includes directing an electrical current through the drive wire
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Abstract
Description
Claims
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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US11/770,386 US8142431B2 (en) | 2007-06-28 | 2007-06-28 | Sphincterotome cutting wire improvement |
PCT/US2008/068011 WO2009006100A2 (en) | 2007-06-28 | 2008-06-24 | Sphincterotome cutting wire improvement |
Publications (2)
Publication Number | Publication Date |
---|---|
EP2170185A2 true EP2170185A2 (en) | 2010-04-07 |
EP2170185B1 EP2170185B1 (en) | 2013-03-13 |
Family
ID=39645450
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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EP08771817A Active EP2170185B1 (en) | 2007-06-28 | 2008-06-24 | Sphincterotome cutting wire improvement |
Country Status (6)
Country | Link |
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US (1) | US8142431B2 (en) |
EP (1) | EP2170185B1 (en) |
JP (1) | JP2010531712A (en) |
AU (1) | AU2008270698B2 (en) |
CA (1) | CA2691423C (en) |
WO (1) | WO2009006100A2 (en) |
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US10806509B2 (en) | 2012-12-27 | 2020-10-20 | Cook Medical Technologies Llc | Method of adhering a conductive coating to an adhesion-resistant outer surface |
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US11737851B2 (en) | 2018-06-28 | 2023-08-29 | Cook Medical Technologies Llc | Medical devices for magnetic resonance imaging and related methods |
CN109480962B (en) * | 2018-12-20 | 2021-07-23 | 深圳开立生物医疗科技股份有限公司 | Cutting wire of cutting knife |
US20200214764A1 (en) * | 2019-01-03 | 2020-07-09 | Boston Scientific Scimed, Inc. | Devices, systems and methods for accessing a body lumen |
US20210244466A1 (en) * | 2020-02-06 | 2021-08-12 | Covidien Lp | Electrosurgical device for cutting tissue |
CN116058930B (en) * | 2023-03-06 | 2023-06-16 | 浙江首鼎医学科技有限公司 | Nipple incision knife based on incision density and incision advantage switching method thereof |
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- 2008-06-24 JP JP2010515031A patent/JP2010531712A/en active Pending
- 2008-06-24 CA CA2691423A patent/CA2691423C/en active Active
- 2008-06-24 EP EP08771817A patent/EP2170185B1/en active Active
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See references of WO2009006100A2 * |
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CA2691423A1 (en) | 2009-01-08 |
JP2010531712A (en) | 2010-09-30 |
AU2008270698A1 (en) | 2009-01-08 |
EP2170185B1 (en) | 2013-03-13 |
AU2008270698B2 (en) | 2013-03-07 |
CA2691423C (en) | 2012-12-18 |
WO2009006100A2 (en) | 2009-01-08 |
WO2009006100A3 (en) | 2009-12-23 |
US8142431B2 (en) | 2012-03-27 |
US20090005778A1 (en) | 2009-01-01 |
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